CABG - Bypass Surgery - Procedure - www.medodeal.com

How do they do it?

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1. The patient is brought to the operating room and moved onto the operating table.
2. An anaesthetist or anesthesiologist places intravenous and arterial lines and injects an analgesic, usually fentanyl, intravenously, followed within minutes by an induction agent, usually propofol or etomidate), to render the patient unconscious.
3. An endotracheal tube is inserted and secured by the anaesthetist and mechanical ventilation is started. General anaesthesia is maintained with an inhaled volatile anesthetic agent such as isoflurane.
4. The chest is opened via a median sternotomy and the heart is examined by the surgeon.
5. The bypass grafts are harvested – frequent vessels are the internal thoracic arteries, radial arteries and saphenous veins. When harvesting is done, the patient is given heparin to inhibit blood clotting.
6. In the case of "off-pump" surgery, the surgeon places devices to stabilize the heart.
7. In the case of "On-pump" coronary artery bypass|on-pump]] surgery, the surgeon sutures cannulae into the heart and instructs theperfusionist to start cardiopulmonary bypass (CPB). Once CPB is established, there are two technical approaches: either the surgeon places the aortic cross-clamp across the aorta and instructs the perfusionist to deliver cardioplegia with a cooled potassium mixture to stop the heart and slow its metabolism or performing bypasses on beating state (on-pump beating).
8. One end of each vein graft is sewn on to the coronary arteries beyond the obstruction and the other end is attached to the aorta or one of its branches. For the internal thoracic artery, the artery is severed and the proximal intact artery is sewn to the LAD beyond the obstruction. Aside the latter classical approach, there are emerging techniques for construction of composite grafts as to avoiding connecting grafts on the ascending aorta (Un-Aortic) in view of decreasing neurologic complications.
9. The heart is restarted; or in "off-pump" surgery, the stabilizing devices are removed. In cases where the aorta is partially occluded by a C-shaped clamp, the heart is restarted and suturing of the grafts to the aorta is done in this partially occluded section of the aorta while the heart is beating.
10. Protamine is given to reverse the effects of heparin.
11. Chest tubes are placed in the mediastinal and pleural space to drain blood from around the heart and lungs.
12. The sternum is wired together and the incisions are sutured closed.
13. The patient is moved to an intensive care unit (ICU) or cardiac universal bed (CUB) to recover. Nurses in the ICU monitor blood pressure, urine output, respiratory status, and chest tubes for excessive or no drainage. Excessive drainage suggests continued bleeding which may require re-operation to manage; no drainage suggests an obstructed tube, which can result in cardiac tamponade and/or pneumothorax which can be lethal.
14. After awakening and stabilizing in the ICU for 18 to 24 hours, the person is transferred to the cardiac surgery ward. If the patient is in a CUB, equipment and nursing is "stepped down" appropriate to the patient's progress without having to move the patient. Vital sign monitoring, remote rhythm monitoring, early ambulation with assistance, breathing exercises, pain control, blood sugar monitoring with intravenous insulin administration by protocol, and anti-platelet agents are all standard of care.
15. The patient without complications is discharged in four or five days.
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